Health Insurance Calculator 2026

Q: What happened to enhanced ACA subsidies in 2026?

Enhanced subsidies from ARPA (2021) and IRA (2022) expired at end of 2025. They were NOT extended by OBBBA. The 400% FPL subsidy cliff has returned — income above 400% FPL means zero Premium Tax Credit. This affects millions earning $60,000-$100,000+.

Q: What is the 400% FPL cliff and why does it matter?

At 400% of Federal Poverty Level ($62,600 single in 2026), your premium subsidy drops from thousands to $0. Even $1 above eliminates your entire Premium Tax Credit — a swing of $4,000+/year for the same Silver plan.

Q: Can I get marketplace subsidies if I have employer insurance?

If your employer's employee-only premium is ≤9.96% of household income, the plan is 'affordable' and you cannot get marketplace subsidies. If it exceeds 9.96%, it's 'unaffordable' and you CAN qualify for subsidies.

Q: What are cost-sharing reductions (CSR)?

CSRs lower deductibles, copays, and OOP maximums on Silver plans. Available at: Silver 94 (up to 150% FPL), Silver 87 (150-200% FPL), Silver 73 (200-250% FPL). Only available on marketplace Silver plans.

Q: What changed with APTC repayment in 2026?

OBBBA eliminated APTC repayment caps for 2026+. If actual income exceeds your estimate, you repay the FULL excess credit with no cap. Accurate income estimation is now critical.

Enhanced subsidies expired. The 400% FPL cliff is back — earning $1 too much can cost you thousands. See your real cost.

Annual household income

Modified Adjusted Gross Income (MAGI)

Family size

Including yourself

Your age

Spouse age (0 = no spouse)

Number of children

Average child age

Used for premium estimate

Tobacco use?

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Enhanced ACA subsidies expired in 2025. The 400% FPL cliff is back — earning $1 too much can cost you thousands in lost subsidies.

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How to Use This Calculator

Tab "Marketplace Subsidy"

Enter your annual household income (MAGI), family size, and age. The calculator estimates your Premium Tax Credit (PTC) based on 2026 ACA rules. With enhanced subsidies expired, the 400% FPL cliff is back — if your income exceeds 400% of the Federal Poverty Level, you get zero subsidy. The "cliff visualization" shows exactly how much that threshold costs you. Under "More options," add spouse and children for family premium estimates.

Tab "Employer vs Marketplace"

Already have employer insurance? Enter your employee premium and household income. The calculator runs the ACA affordability test (9.96% of income threshold). If your employer plan is "unaffordable," you can qualify for marketplace subsidies — potentially saving thousands. If it's "affordable," you're locked into the employer plan for subsidy purposes.

Tab "Coverage Gap"

Retiring before 65? Enter your age, expected retirement income, and COBRA premium. The calculator compares COBRA vs. marketplace for your entire gap until Medicare at 65 — showing total cost for each strategy and recommending the cheaper path.

The Formulas

Premium Tax Credit (PTC):
FPL = $15,650 + $5,500 × (family size − 1)
FPL% = Household income ÷ FPL × 100
Expected contribution = Income × Applicable Percentage
Monthly PTC = (Benchmark Silver premium − Expected contribution) ÷ 12
Your cost = Full premium − PTC

Applicable Percentage Table 2026 (Rev. Proc. 2025-25):
≤133% FPL: 2.10%
133–150% FPL: 3.14% → 4.19%
150–200% FPL: 4.19% → 6.60%
200–250% FPL: 6.60% → 8.44%
250–300% FPL: 8.44% → 9.96%
300–400% FPL: 9.96%
>400% FPL: No subsidy (cliff)

Employer affordability test:
Employee-only premium ÷ Household income ≤ 9.96%
If "affordable" → no marketplace subsidy available

Age rating (45 CFR 147.102):
Premium = Benchmark × Age factor (3:1 ratio, age 21 = 1.000, age 64 = 3.000)
Up to 3 children under 21 are rated; additional children are free

2026 marks the return of the "subsidy cliff" at 400% FPL after enhanced subsidies (ARPA 2021, IRA 2022) expired without extension. The One Big Beautiful Bill Act (OBBBA) did not extend them but did eliminate APTC repayment caps — meaning if you underestimate your income, you repay the full excess credit.

Example

Sarah — Freelance Designer, Age 38, Single

Household income $48,000. Family size 1. Non-smoker. Looking at marketplace coverage in 2026.

Federal Poverty Level (1 person)$15,650

Income as % of FPL307%

Applicable percentage9.96%

Full Silver premium (age 38)$937/mo

Expected contribution$4,781/year

Monthly PTC$539/mo

Sarah's monthly cost$398/mo

Sarah saves $6,468/year with her PTC. But she's watching the cliff carefully — if a good freelance year pushes her above $62,600 (400% FPL), she'd lose the entire subsidy and owe $937/month. She shared the calculator: "I had no idea $1 of income could cost me $6,000 in subsidies."

Frequently Asked Questions

What happened to enhanced ACA subsidies in 2026?▼

The enhanced subsidies from the American Rescue Plan Act (2021) and Inflation Reduction Act (2022) expired at the end of 2025. They were NOT extended by the One Big Beautiful Bill Act (OBBBA). This means the 400% FPL "subsidy cliff" has returned: if your income exceeds 400% of the Federal Poverty Level, you receive zero Premium Tax Credit. During 2021-2025, there was no cliff — subsidies gradually phased out at higher incomes. For 2026, this change affects millions of households earning $60,000-$100,000+.

What is the 400% FPL cliff and why does it matter?▼

The "cliff" means that at exactly 400% of the Federal Poverty Level ($62,600 for a single person in 2026), your premium subsidy drops from potentially thousands of dollars to exactly $0. Even $1 of additional income above this threshold eliminates your entire Premium Tax Credit. For a 40-year-old single person, this can mean the difference between paying ~$400/month and ~$750/month for the same Silver plan — a swing of over $4,000/year. Managing your MAGI to stay below this cliff is one of the most impactful financial planning moves for marketplace enrollees.

Can I get marketplace subsidies if I have employer insurance?▼

It depends on the "affordability test." If your employer's employee-only premium is 9.96% or less of your household income (2026 threshold), the plan is considered "affordable" and you cannot receive marketplace subsidies — even if family coverage is expensive. If the employer plan exceeds 9.96%, it's "unaffordable" and you CAN get marketplace subsidies. Note: the test uses employee-only cost even if you need family coverage (the "family glitch" was fixed in 2023, but affordability is still measured on employee-only cost for the employee).

What are cost-sharing reductions (CSR)?▼

Cost-sharing reductions lower your deductibles, copays, and out-of-pocket maximums on Silver plans. They're available at: Silver 94 (up to 150% FPL, 94% actuarial value), Silver 87 (150-200% FPL), and Silver 73 (200-250% FPL). Standard Silver plans are 70% AV. CSRs are only available on Silver plans purchased through the marketplace — this is why financial advisors often recommend Silver plans for lower-income enrollees even if Bronze premiums are lower.

What changed with APTC repayment in 2026?▼

The One Big Beautiful Bill Act (OBBBA) eliminated the repayment caps for excess Advance Premium Tax Credits starting in 2026. Previously, if your actual income exceeded your marketplace estimate, repayment of excess APTC was capped based on income level. Now there is no cap — you must repay the FULL amount of any excess credit. This makes accurate income estimation critical. If you claim $500/month in APTC but your actual income qualifies you for only $200/month, you'll owe the full $3,600 difference at tax time.

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